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SAN OAQUIN COUNTY PUBLIC HATH SERVICES <br /> UNDEAGROUND 910PAGE TANK PROGRAM - FEE WORKSHEET <br /> KADDRESS <br /> NAME1 ACILITY CONTACT NAME <br /> /E7C�1z <br /> "� , ITE PHONE N WITH AREA CODE <br /> T6TE IP CODE of Tanks�' t SiteING NAME PPLICANT CONTACT NAM ,Fl��-d II, fl wc- rSvPPLICANT PHONE N WITH/ 3vTATE IP CODE Llf.i�1'IY <br /> {/' <br /> �/1^ LOSURE, IN TALL)P�:� IIAA Aft <br /> lJ d <br /> ACILITY FEE • 5100.00 each SITE ADDRESS per YEAR TOTAL , <br /> 1 <br /> 1 1986 1987 1988 1989 <br /> ARK FEE + $50.00 each TANK <br /> Jr Tanks x $50.00 1986 1987 1988 1989 <br /> multiplV N by fe! for <br /> each year App(icable) <br /> - S 0 Sz, <br /> TATE SURCHARGE • SS6.00 each TANK (see CA HEALTH d SAFETY CODE Sec 25287 for applicability) <br /> I <br /> Tanks x $56.00 1986 1987 <br /> enter aawnt and year) 1988 1989 <br /> j <br /> ERMANENT CLOSURE (Removal or Closure-In-place) <br /> .LOSURE FEE + $90.00 each TANK N Tanks x $90-00 <br /> EMPORARY CLOSURE (Only allowed one tiara for LIP to two years) <br /> EMPORARY CLOSURE FEE • 180.00-lath TANK N tanks x $80.00 <br /> LAN CHECK (Installation or Repair') <br /> LAN CHECK FEE + $30.00 each SU8MIS9ION/RESUBMISSION <br /> LREPAIR <br /> EE $110.00 each TANK N Tanks x $110.00/CLOSURE/REMOVAL (Fees are per hour, minlmm one hour to be paid on plan submittal) <br /> RELEASE EVALUATION ONSTRUCTION INSPECtICN AMPLING INSPECTION <br /> ble) when applicable) when applicable) <br /> hr EE a $35.00/hr EE _ $35.00/hr <br /> TOTAL DUE <br /> OFFICE USE ONLY 10 <br /> s:•ume@aa:�a�ma�:a�a�aQ�a�a@aa:aa'ma�a���Qea:aaQesea�o�aa mom <br /> um aaaea� umumaa as mammae: umata umuma+ uamn� <br /> c SWEEPS N COMP N LDC Coot DIST CODE AMOUNT DUE AMOUNT RCVD HECK N/CASH RCVD BY DATE RECEIVED PERMIT N o <br /> - - - -��� _ <br /> .o...aamama - - - - - <br /> , t�y���amamomamaiimseaeaoma ____-•-----_- --____-_- <br /> [11 [J matin.WlmaaaMiamma�emmaamamaoioamamaeomua�u-o <br /> • ma+a+mumumaamaaumaa•r <br />